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Pins and needles

At a meeting of the Royal Medical and Chirurgical Society in 1852, London physicians were treated to the following tale, as later reported in the Medical Times:

A tradesman’s wife, aged 41 at the time of her death, who had borne six children—the last in 1844—a tall, well-formed woman, who had suffered from the following symptoms :—In December, 1842, fourteen days after the birth of her fifth child, she vomited a wash-hand-basinful of blood.

Crikey. That is a lot of blood.

For forty-eight hours subsequently she was unconscious; the pupils were dilated, and the pulse hardly to be felt. She recovered slowly, and her complexion always afterwards retained a sallow hue. The last labour, in 1844, was unattended by any similar or other ailment, and she recovered quickly. In the autumn of 1845, she suffered from pain at the epigastrium and in the left groin, accompanied with frequent vomiting.

The epigastrium is the upper part of the abdomen, between the chest and the navel.

A hard tumour, the size and shape of an ordinary placenta, was found in the left groin, movable in a transverse direction when the patient turned from side to side. This had been felt by the patient for many months; when it moved it caused nausea, but no pain, nor was it tender to the touch. She had pain between the shoulders, shooting into the left breast, and suffered much from flatulence.

The woman had not menstruated for three months, and believed that she was pregnant. The cause of her condition, however, was something far more serious.

The bowels were constipated, the vomiting continued, with occasional mixture of blood in the matters thrown up; she became much emaciated, and so feeble that her death was expected. She recovered, however, after taking nothing but small quantities of brandy at short intervals for two days.

The patient was almost back to her usual self, her appearance apparently returned to normal.

During the five following years, she continued in tolerable health: the pain and occasional sickness, constipated state of bowels, and occasional oedema of face and ankles, were the principal indications of impaired health. The catamenia had never returned since 1845. In October, 1850, after a return of the old symptoms of incessant vomiting, etc., she sank after an illness of three weeks.

The woman’s doctor requested a post-mortem, which produced some surprising results. The stomach was grotesquely distended, ‘its form resembling that of a champagne-bottle’. Other organs including the large intestine, pancreas and liver were displaced from their natural positions. But the most unusual findings were inside the gastrointestinal tract:

The stomach contained in its lower half, nine ounces of pins of a purple-black colour, not corroded, all bent or broken, many very pointed. The coats of the stomach were much thickened; the duodenum contained a mass of pins very tightly packed, of various shapes, similar to those found in the stomach, and wholly obstructing the tube. Their weight was about a pound.

Given the mass of a single pin (a few grams), and the fact that she had swallowed over 750g of them, this ‘mass of pins’ must have contained several hundred at least.

The husband of the patient had never seen her put pins into her mouth, but her son said that he had observed his mother biting pins, and believed that she swallowed them; and stated, moreover, that he had occasionally taunted her with the fact, when she corrected him. It appeared that her appetite was always capricious, occasionally very keen; and her sister informed the author that when a child she was in the habit of eating starch and slate-pencil, and that she had seen her biting pins. At seventeen years of age, she had vomited blood, and was ill for some time afterwards.

A sad case. It sounds very much like a case of pica, a disorder characterised by the compulsive consumption of inappropriate substances. Pica is particularly associated with pregnancy – and it may well be that this poor woman’s condition was exacerbated by the hormones and physiological peculiarities that manifest during pregnancy.